Friday, October 10, 2014

Warsaw Indiana, an interesting case

We are back in Warsaw Indiana completing obligations here for CRBCM.
This exercise also expose us to local pathology and ways they are managed by local Oncologist.
An interesting case encounter here is that of a 22 year young mother who had 2 c-sections and was referred for Menorrhagia, she had a Biopsy of the Uterus, and a Von-Willebrand screen suggested very elevated Factor VIII  (3 times the upper limit).    She is obese and suffers from Hypothyroidism.  Now elevation of Factor VIII has been identified as an independent factor determining an Hypercoagulable state.  We may soon be quantifying related gene.  This Hypercoagulable state is however confusing because it is indeed associated with higher risk of stroke and Coronary events.  However, independent of thrombotic event, does it really require Anti-Coagulation for life?
The patient has been advised Aspirin,  do we  justify Xarelto at preventive dosage?  Should weight loss be a sufficient intervention, should we look for coexisting Hercoagulable factor such as Factor V leyden, or Homocystein for that matter...we are checking TSH level of course...Elimination of this factor is associated with certain Blood Group,  should we type and cross ?  Very puzzling case indeed!  What are the genes proximate to this gene?
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